Provider Demographics
NPI:1447371166
Name:LARSON, CURTIS WAYNE (BCHIS)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:WAYNE
Last Name:LARSON
Suffix:
Gender:M
Credentials:BCHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 S POKEGAMA AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-4208
Mailing Address - Country:US
Mailing Address - Phone:218-326-5986
Mailing Address - Fax:218-326-0743
Practice Address - Street 1:1275 S POKEGAMA AVE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-4208
Practice Address - Country:US
Practice Address - Phone:218-326-5986
Practice Address - Fax:218-326-0743
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2013237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist